Provider Demographics
NPI:1932394061
Name:SONG, YOUNG MIN (MD)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:MIN
Last Name:SONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:
Other - Last Name:SONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2450 E RIVER RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-6522
Mailing Address - Country:US
Mailing Address - Phone:520-795-7750
Mailing Address - Fax:529-320-2155
Practice Address - Street 1:2450 E RIVER RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-6522
Practice Address - Country:US
Practice Address - Phone:520-795-7750
Practice Address - Fax:520-320-2155
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ432812084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA105993OtherMEDICAL BOARD
AZ523941Medicaid
AZ43281OtherAZ MEDICAL BOARD
Z137907Medicare PIN